It All Started With a Broken Leg
A broken leg is a none-too-pleasant experience, but one that doesn't usually end in life-threatening manner.
It all started simply enough: my partner Jim, came running in off our deck and slid on our wet laminate flooring. I heard the thud and went running, calling, "Are you okay?" Just as I arrived, Jim nonchalantly replied: "I don't think so. I think I broke my leg."
Jim Was Taken by Ambulance to the Hospital
Jim broke both his tibia and fibula near the ankle. It was Friday night so his leg was splinted and he was given painkillers to keep him comfortable. On Monday, the orthopedic doctor operated and inserted a metal rod in his tibia.
He remained in the hospital until the next day when he was visited by physical therapy and shown how to use a walker. He was allowed "toe touch" only, no weight, on the broken leg.
The hospital social worker and his physician suggested that Jim go to a rehab facility to get this strength back and learn to walk properly on the broken leg. The doctor and social worker didn't feel that Jim could be taken care of properly at home and that he would benefit from physical therapy. As Jim was on Medicare, this service would be covered after his three-day stay in the hospital.
We were given a long list of rehabilitation facilities and told to pick a first, second, and third choice. Jim asked me to do the picking, and right away I recognized one that was a nursing home I had investigated for my parents. At that time I had checked out their rating on the Medicare website. They had a very high rating.
The Nursing Home/Rehab Was Warm and Friendly
Jim was checked into a private room. This nursing home had a folksy friendly atmosphere. All the patients seemed content and well cared for.
Jim had two incisions on his leg from the surgery to insert the rod. One was near his ankle and the other near his knee. Twice a day a nurse would come and clean his wounds and change the dressing.
Physical therapy would come and get him several times a week to practice walking on the parallel bars without putting pressure on the broken leg. They also had him work out with handheld weights to build his upper body strength. After bed for so many days, patients, especially senior citizens, lose upper body strength.
Someone told me, for every one day in bed, a patient needs three days of rehab to build back their strength. I am not sure if this is true, but it is something to consider.
Jim Was Making Progress
Jim was coming along nicely. He lost that lethargic washed-out feeling he had from being in a hospital bed for days.
Our only concern was that while we noticed the incision near his knee was almost healed, the one near his ankle was actually opened more. Also, the wound was discharging fluid.
When mentioned it to the nurse doing the dressing changes, said that sometimes that happens and it's normal.
But then we noticed whenever he went to physical therapy, it opened more. Once again we mentioned it to a nurse on duty. She had their resident doctor look at it and they assured us it was perfectly fine.
Jim Was Making So Much Progress He Was Getting Restless
Jim wanted to go home badly. Not the kind to sit still, he was so restless, he kept asking to go home.
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The social worker spoke to us and suggested that if Jim wanted to go home, we get home health care for a while just to be on the safe side. Medicare would cover the cost for a certain period of time. We would be visited by nurses and also a physical therapist.
We were asked to pick a service from a list of providers. I picked the one administered by the hospital where his surgery was performed. My thinking was that they would have online access to all his records and this would make everything smoother. This turned out to be a misconception on my part.
Our Home Health Care Was Far From Caring
After all the paperwork at the home, we left late and got home pretty late on a Friday. I fixed dinner and then I rearranged the bedroom furniture to make a clearer path to the bathroom. I set up another beside table for Jim so he could reach his necessities. We got to bed late.
At 7:00 a.m. on Saturday I received a phone call from the home health care nurse. She tells me that she is coming over in an hour. I told her I couldn't possibly get the two of us up and dressed by then. She said: "You are going to have to find a way."
When she arrived, she had one of the worse coughs I had ever heard. She did cover her mouth with her arm, but the cough was, quite frankly, disgusting. She proceeded to spend over an hour taking case history information, which is what I had wrongly assumed her agency, as a hospital affiliate, would already have access to. She took Jim's vitals.
The Next Two Nurses Did Not Instill Confidence
While the physical therapist who visited us seemed professional and personable, I can't say that for the next two nurses.
On Wednesday, we were visited by yet a different nurse. She smelled so much of cigarette smoke that I could not stand near her without my eyes tearing up.
She looked at the wound on Jim's ankle and said it didn't look good and wanted to put some Bacitracin (antibiotic salve) on it. Unfortunately, she didn't have any so she borrowed my Neosporin (antibiotic salve). She felt the wound and took Jim's temperature.
Shortly thereafter Jim's wound started to hurt a little, also we could see into it and see a white area.
On Friday, we were visited by a perky nurse who seemed to find everything amusing and giggled. She told us that she was really supposed to be our nurse but didn't have time to come see us. I asked if going forward she would be our nurse and she said she didn't think she would have the time.
She too looked at Jim's wound and felt it and took his temperature.
By Friday Night Jim Was in Horrible Pain
Jim indicated his leg hurt badly and I offered to take him to the ER. He said we should wait. Around 3:00 a.m. on Sunday morning he couldn't take the pain any longer and we went to the ER.
They cultured the wound, and then gave him antibiotics and pain medicine. They admitted him to the hospital and put him in an isolation room until they could determine if he had MRSA. After three days they found out he had staph, but it wasn't MRSA.
We learned that the patch of white we were seeing in the wound was actually Jim's bone. I understand why we didn't recognize it as bone, but I wondered why didn't the nurse who visited us on Friday hadn't recognized it.
He had to have the skin on the wound debrided, which basically means they remove the contaminated tissue. The orthopedic doctor also had to perform another surgery to remove the rod so the staph wouldn't travel up the rod.
Because of the infected wound, the doctor couldn't put a cast on, and he couldn't put a rod in so he had to stabilize his leg by putting on an external fixator on (see the photo at the top of the page).
The orthopedic doctor told us there was a chance Jim's leg might have to be amputated.
Our orthopedic doctor questioned why we didn't call him when the wound wasn't healing. Simple! In the nursing home, we were assured there was nothing to worry about. Then, when we returned home, three nurses looked at it and were not concerned.
Months of Treatment Followed
Jim was in the hospital for over two weeks. Then he was released to another nursing home. He couldn't come home as he had to be in a facility where they could administer intravenous antibiotics. His antibiotics were prescribed by, and under the supervision of an infectious disease physician.
He was also fitted with a wound vac. It's a device that sucks fluid out of the wound and enables the skin to grow back and close the wound. This was being monitored by a reconstructive plastic surgeon.
Jim broke his leg in May. He had the external fixator on his leg until August. When the wound was healed and the wound vac could be removed, the fixator was removed and replaced with a cast—at which point he was on oral antibiotics and could come home.
He was in a cast for yet another month.
We continued to visit the infectious disease doctor who did blood tests. He indicated the blood tests still showed "something" in the blood and if it didn't clear up, Jim might need his leg amputated. Luckily that didn't happen—but it was hard to hear, over and over again.
What We Would Do Differently Next Time
- Although I knew the nursing home was highly rated, I had never checked it out as far as a rehabilitation facility. Some facilities are more geared to rehab and physical therapy. I now know which ones those are.
- I picked the home health care worker service just because it was affiliated with our hospital. I thought they were all the same. After Jim's second stay in a rehab facility (the one that had the capability to administer intravenous antibiotics and tend to the wound vac) we had home health care through a different agency. Every nurse that came was professional. The difference between this agency and the first, was like night and day. I should have asked other people who had used home health care or check comments on the internet.
- I learned, from speaking to health care professionals, that nurse #2, should have never put an ointment or salve in a wound that was presumed infected. Antibiotic salves are used to prevent infection, but not used in an infected open wound.
- I would go with my gut. If something seems to be wrong, it probably is.
How to Find Providers
- Find and compare doctors, hospitals, and other providers | Medicare.gov
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- Medicare.gov Nursing Home Compare
Search by zip code or city and compare Medicare and Medicaid-certified nursing homes and view the quality of care provided to patients. It rates each home on several criteria and also gives and overall rating for each facility.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2015 Ellen Gregory